1. Late Distal Tubule and Cortical Collecting Tubule Composed of two distinct cell types, the principal cells and the intercalated cells The principal cells reabsorb sodium and water from the lumen and secrete potassium ions into the lumen The intercalated cells reabsorb bicarbonate and potassium ions and secrete hydrogen ions into the tubular lumen

2. Principal Cells Reabsorb Sodium and Secrete Potassium Sodium reabsorption and potassium secretion by the principal cells depend on the activity of Na-K ATPase pump. The secretion of potassium by these cells from the blood into the tubular lumen The principal cells are the primary site of action of the potassium sparing diuretics sodium channel blockers as well as the aldosterone antagonists decrease urinary excretion of potassium and act as potassium-sparing diuretics

3. Intercalated Cells Avidly Secrete Hydrogen and Reabsorb Bicarbonate and Potassium Ions Hydrogen ion secretion by the intercalated cells is mediated by a hydrogen-ATPase transport mechanism. The intercalated cells can also reabsorb potassium ions

4. Tubular Secretion In distal convoluted tubules, potassium ions or hydrogen ions may be passively secreted in response to active reabsorption of sodium ions

5. The functional characteristics of the late distal tubule and cortical collecting tubule can be summarized The late distal tubule and the cortical collecting tubule segments reabsorb sodium ions, and the rate of reabsorption is controlled by hormones, especially aldosterone. These segments secrete potassium ions a process that is also controlled by aldosterone The intercalated cells play a key role in acid-base regulation of the body fluids. The permeability of the late distal tubule and cortical collecting duct to water is controlled by the concentration of ADH. With high levels of ADH, these tubular segments are permeable to water, but in the absence of ADH, they are virtually impermeable to water.

6. Medullary Collecting Duct The medullary collecting ducts reabsorb less than 10 per cent of the filtered water and sodium The epithelial cells of the collecting ducts are nearly cuboidal in shape with smooth surfaces and relatively few mitochondria

7. The permeability of the medullary collecting duct to water is controlled by the level of ADH The medullary collecting duct is capable of secreting hydrogen ions. Thus, the medullary collecting duct also plays a key role in regulating acid-base balance.

8. Peritubular Capillary and Renal Interstitial Fluid Physical Forces Hydrostatic and colloid osmotic forces govern the rate of reabsorption across the peritubular capillaries. The normal rate of peritubular capillary reabsorption is about 124 ml/min. Reabsorption = Kf x Net reabsorptive rate

10. Regulation of Peritubular Capillary Physical Forces Increases in arterial pressure tend to raise peritubular capillary hydrostatic pressure and decrease reabsorption rate. This effect is buffered to some extent by autoregulatory mechanisms that maintain relatively constant renal blood flow as well as relatively constant hydrostatic pressures in the renal blood vessels. Increase in resistance of either the afferent or the efferent arterioles reduces peritubular capillary hydrostatic pressure and tends to increase reabsorption rate. Increasing the plasma protein concentration of systemic blood tends to raise peritubular capillary colloid osmotic pressure, thereby increasing reabsorption

11. Hormonal Control of Tubular Reabsorption Aldosterone Increases Sodium Reabsorption and Increases Potassium Secretion The primary site of aldosterone action is on the principal cells of the cortical collecting tubule The mechanism by which aldosterone increases sodium reabsorption while at the same time increasing potassium secretion is by stimulating the sodium-potassium ATPase pump

12. Angiotensin II Increases Sodium and Water Reabsorption Angiotensin II the body's most powerful sodium-retaining hormone Angiotensin II formation increases in circumstances associated with low blood pressure and/or low extracellular fluid volume Angiotensin II stimulates aldosterone secretion, which in turn increases sodium reabsorption. Angiotensin II constricts the efferent arterioles by efferent arteriolar constriction reduces peritubular capillary hydrostatic pressure, which increases net tubular reabsorption

13. Angiotensin II directly stimulates sodium reabsorption in the proximal tubules, the loops of Henle, the distal tubules, and the collecting tubules. One of the direct effects of angiotensin II is to stimulate the sodium-potassium ATPase pump on the tubular epithelial cell basolateral membrane. A second effect is to stimulate sodium-hydrogen exchange in the luminal membrane, especially in the proximal tubule. Thus, angiotensin II stimulates sodium transport across both the luminal and the basolateral surfaces of the epithelial cell membrane in the tubules.

14. ADH Increases Water Reabsorption ADH increases the water permeability of the distal tubule, collecting tubule, and collecting duct epithelia. In the absence of ADH, the permeability of the distal tubules and collecting ducts to water is low, causing the kidneys to excrete large amounts of dilute urine.

15. Atrial Natriuretic Peptide (ANP) Decreases Sodium and Water Reabsorption Specific cells of the cardiac atria, when distended because of plasma volume expansion, secrete a peptide called atrial natriuretic peptide Increased levels of this peptide in turn inhibit the reabsorption of sodium and water by the renal tubules, especially in the collecting ducts This decreased sodium and water reabsorption increases urinary excretion

16. Parathyroid Hormone Increases Calcium Reabsorption Parathyroid hormone is calcium-regulating hormones Its principal action in the kidneys is to increase tubular reabsorption of calcium, especially in the distal tubules